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SAN-,tJ0AQU IN Environmental Health Department <br /> COUNTY <br /> Sweet Sorghum Roasted Coffee <br /> ❑ Syrup El (Beans/Grounds) Chocolate Covered Nonperishable Food <br /> ❑ Fried or Baked ❑ Dried Hot Chocolate ❑ Other <br /> Donuts and Waffles <br /> Do not contain eggs, cream, or cream cheese <br /> If preparing jams,jellies or fruit butters, include a list of ingredients(attach separate page if needed). These items <br /> must comply with standards described in Part 150 of Title 21 of the Code of Federal <br /> Regulations http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> Vr SvAi �� ST(�Awbefcy bCnana\ <br /> e)VC,��V MRr -S &N J:, C017�lnl 3©v( C- <br /> c �acolc��eG�iO rno�l�S . Nl�r�� iw- nv4 wkit, c6o Io O -ck' fil l Mlle wA <br /> �w Jf CH0C61kAt Ca/�p� S�r��h ��PS ,Ca;11P-' 0/)A Virntll� �� �rtic I{ ����c'�4A��, <br /> \L/Ic-e I vVAI/1S h4 -(e f1ovl- Svvr, <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />